Maternal-Child Nursing Care Optimizing Outcomes for Mothers
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Transcript Maternal-Child Nursing Care Optimizing Outcomes for Mothers
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Physiological Transition of the
Newborn
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Question 1
A newborn is placed under a radiant heat warmer.
The nurse knows that thermoregulation presents a
problem for newborns because:
a. Their renal function is not fully developed, and
heat is lost in the urine.
b. Their small body surface area favors more rapid
heat loss than does an adult’s body surface area.
c. They have a relatively thin layer of subcutaneous
fat that provides poor insulation.
d. Their normal flexed posture favors heat loss
through perspiration
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Adaptations of the
Respiratory System
Intrapulmonary fluid
Reduces pulmonary resistance to blood flow
Facilitates initiation of air breathing
Surfactant
Decreases surface tension within alveoli
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
The First Breath
Internal stimuli
Chemical factors
External stimuli
Sensory factors
Thermal factors
Mechanical factors
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Cardiopulmonary Transitions
Increased pulmonary blood volume
Conversion from fetal to neonatal circulation
Immediate assessment necessary
Skin color
Respiratory rate; breathing pattern
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Cardiopulmonary Adaptation
Increased aortic pressure and decreased venous
pressure
Increased systemic pressure and decreased pulmonary
pressure
Closure of foramen ovale, ductus arteriosus, and
ductus venosus
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Assessing the
Cardiovascular Transition
Pulse
Within 30 minutes—120 to 160 bpm
Capillary refill
<3 seconds adequate
>4 seconds possible underlying problem
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Thermogenic Adaptation
Newborns are homeothermic
Neutral thermal environment
Cold stress
Large body area
Limited subcutaneous fat
Limited ability to shiver
Thin skin and blood vessels close to surface
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Adaptations to Increase
Heat Production
Increased BMR and muscle activity
Peripheral vasoconstriction
Nonshivering thermogenesis
Brown adipose tissue
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Mechanisms for
Neonatal Heat Loss
Evaporation
Insensible water loss
Conduction
Convection
Radiation
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Hematopoietic Adaptation
Blood volume
Blood components
Erythrocytes and hemoglobin
Hematocrit
Leukocytes
Platelets
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Hepatic adaptation
Glycogen and blood glucose maintenance
Iron storage
Conjugation of bilirubin
Coagulation of blood
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Hyperbilirubinemia
Physiologic jaundice—appears 24 to 48 hours after
birth; transient
Pathologic jaundice—present at birth or within 24
hours
Breastfeeding jaundice—2 to 4 days
Breast milk jaundice—7 days; peaks at 10 days
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Susan Ward
Shelton Hisley
Gastrointestinal Adaptation
Stomach and digestive enzymes
Intestinal peristalsis
Meconium
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Genitourinary Adaptation
Kidney function
Bladder capacity 6 to 44 mL
Fluid requirements—60 to 80 mL/kg
Urine output 1 to 3 mL/kg/hour
Nursing assessments
Careful monitoring of I/O
Assess appearance of urine
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Immunological Adaptation
Active acquired immunity
Passive acquired immunity
Immunoglobulins
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Psychosocial Adaptation
Early stages of activity
First period of reactivity
Period of inactivity and sleep
Second period of reactivity
Susan Ward
Shelton Hisley
Maternal-Child Nursing Care
Optimizing Outcomes for Mothers, Children, & Families
Behavioral
States
Sleep
Deep, quiet; REM
Alert
Drowsy/semidozing
Wide awake
Active awake
Crying
Susan Ward
Shelton Hisley